From antiquity to the 20th century, preventive medicine was not bad. The Torah (Leviticus 12-13) already knows about quarantine as a method to contain communicative diseases, and the Talmud knows about such things as the importance of fruits and vegetables in one’s diet, the dangers of obesity, and many other aspects of taking care of our health that our doctors still recommend today. Moreover, the psychosocial aspects of care of the sick were arguably better than what we do today because when you were sick, you were at home among family and friends rather than in a hospital or nursing home. Curative medical treatment, though, was largely ineffective and was, therefore, inexpensive.
This changed dramatically with the advent of antibiotics (penicillin came into widespread usage in the early 1940s), followed by a host of other new medicines, vaccines and surgical procedures discovered or invented in the last half of the 20th century and continuing into the present. Some of these new interventions are relatively inexpensive, but many cost quite a bit, and some are very expensive. As a result, only the very rich can afford many medical interventions available today, and all too many of us cannot afford even visits to primary care doctors.
Canada, Western European countries and Israel responded to this situation through instituting a system of socialized medicine in which the government pays for both primary care and more expensive interventions for every citizen (and often tourists, too). Socialized medicine has its own problems. It is often hard to add to the package of services available as medicine develops, and people need to wait in line, sometimes for months, for important and effective surgeries that are not emergencies (such as hip replacements). Even so, for decades now, nations with socialized medicine have provided access to health care for all of their citizens.
Virtually alone among democracies, the United States has failed to do that. American individualism, at the root of some of the great blessings of freedom and pluralism of our country, is also the ultimate cause of our inability as a nation to come together to provide health care for us all, in shameful contrast to all the other Western democracies. President Barack Obama’s Affordable Care Act (“ObamaCare”) is a plan finally to enable us to accomplish that end. Still, it was adopted in Congress by a slim margin, only after prodigious effort on the part of the president and his allies, at the cost of a number of members of Congress losing their seats in the subsequent 2010 election, and it has now been approved as constitutional by the slimmest of majorities of the Supreme Court as well. Furthermore, Republicans now vow to repeal the law, primarily because it imposes a duty on all Americans to contribute to the health care of us all. American individualism does not succumb easily to demands of the government, even for a plan to help us all as an American community.
Moreover, the president’s plan is a uniquely American way to provide health insurance for us all. It is not socialized medicine, for it is private parties, not the government, which will provide the medical care. The government, though, will function to organize insurance pools to act as the insurer of last resort for those who do not get health insurance from their employers and who cannot afford it on their own. Thus the American values of individualism and private enterprise are retained in the president’s health plan.
As American Jews, we inherit not only the American heritage of Western liberalism, but also the Jewish heritage that is much more communitarian, that requires us as a community to take care of the poor and sick in our midst. The Torah has multiple rules that require us to take care of the poor, and the rabbis added even more. Based on the Torah’s demands not to stand idly by the blood of your brother (Leviticus 19:16) and to love your neighbor as yourself (Leviticus 19:18), later rabbis extended this duty to the sick as well. The Jewish part of us, therefore, applauds loudly for the fact that we Americans have finally found a way to come together to achieve this morally important goal.
But the American part of our identity must also applaud. Pragmatism, after all, is also part of our American heritage. This includes the theory of pragmatism (e.g., Charles Sanders Peirce, William James, John Dewey, Richard Rorty) as well as the impressive achievements by Americans in all areas of engineering and technology. We are, in a significant sense, the “can do” society.
Until the new legislation, however, people without health insurance or who are underinsured have obtained the services they need but in the most expensive way possible — through the emergency room. This is not only morally problematic because it forces people to suffer the pain of diseases often for months or years before they get medical help, it is also fiscally irresponsible. It is no wonder that for the last 20 years, we Americans have been spending 15 to 18 percent of our gross national product on health care while Canadians, Europeans and Israelis have spent half that, and, according to annual United Nations ratings, they get much better results in health outcomes than we do.
So the pragmatic, American side of us, as well as the morally insistent Jewish side of us, should celebrate the fact that we as a nation finally have a way to provide for health care for us all. May it be put into effect fully and speedily.
Rabbi Elliot N. Dorff is the Distinguished Professor of Philosophy at American Jewish University and chair of the Conservative movement’s Committee on Jewish Law and Standards.